INTRIM NARRATIVE REPORT. PROJECT: Provision of Emergency Health Service in Afmadow district, Lower Juba Region, Somalia.

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REPORTING PERIOD: 11 th April 2017-30 th

1 INTRIM NARRATIVE REPORT PROJECT: Provision of Emergency Health Service in Afmadow district, Lower Juba Region, Somalia. REPORTING PERIOD: 11 th April th June 2017 COMPILED BY: Mohamed Bashir- Executive Director-SFH Figure 1: Photos (SFH): TOP: Preview of Mobile teams undergoing the induction sessions facilitated by IOM Health officer. Down: The teams on actual duty at the field in Dobley. 1

2 ACKNOWLEDGEMENT With profound gratitude, I would like to convey my sincere regards, to everyone who contributed to the successful achievement so far on the ongoing program. Indeed this interim report could not have been accomplished without the substantial and courteous cooperation of all of you. I am greatly indebted and wish to acknowledge the role played by IOM technical Health officer in Dobley, Mr. Farah who was resourceful in the initial program roll-out, teams inductions, sharing the relevant program registers, monitoring tools and the supportive supervision throughout the period. I also wish to extend my sincere appreciation to entire SFH mobile teams both in Dobley and Hosingo for the diligent work so far. Finally, allow me to extend heartfelt gratitude to other indirect technical team in IOM and SFH who provided guidance and support in the background during the project implementation. 2

3 TABLE OF CONTENT: Acknowledgement Acronyms Executive Summary Background Information General Objectives Specific objectives Progress toward realizing outcomes A) General Achievements B) Expected Outputs C) Gender Indicators D) Other deliverables achieved Referrals Challenges Recommendations

4 ACRONYMS IOM SFH PHC MCH OPD ANC PNC RTI MUAC SCZ EPI OTP IDP AWD MOH HHN International Organization for Migration Solutions for Humanity Primary Health Care Mother and Child Health Out-Patient Department Antenatal Care Postnatal Care Respiratory Tract Infections Mid-Upper Arm Circumference South Central Zone Expanded Immunization Program Outpatient Therapeutic Program Internally Displaced Persons Acute Watery Diarrhea Ministry of Health Health, hygiene and Nutrition 4

5 1. EXECUTIVE SUMMARY This Interim report is an output of the activities implemented during 1 st May to 30 th June The activities were implemented by 3 mobile teams in Dhobley and Hosingo towns. Two (2) teams are based in Dhobley and its neighboring villages and the 3 rd team was based in Hosingo. A mobile team comprised of: Qualified nurse, Auxiliary nurse, Pharmacist, Mid-wife, Health promoter/crowd controller and a vaccinator. The principle objective of the project is: To provide emergency health services in Afmadow districts of lower juba districts and part of Badhadhe. The clinics provides health, hygiene and nutrition (HHN) promotion services, reproductive health services (ANC/PNC, skilled assistance at birth) and operates the outpatient department including extended Programme on immunization (EPI) services. The teams also have fully functioning pharmacy services. The following are key achievements so far: 9219 OPD Consultations and managements done during the period 4418 persons received direct HHN promotion sessions 323 Antenatal clients were seen and supported and 171 Post-natal clients consulted during the period 1302 Women of child baring age (WCBA) received essential treatments Using MUAC screening 57 acutely malnourished cases identified with 9 severely malnourished and referred for secondary health services There was good compliance of standard protocol by all teams. The interim recommendations: a) All possible efforts should be made to continue providing the vital services in all the accessible health facilities in Badhadhe with the inclusion of more community outreach component (Mobile) to the accessible rural villages within a radius of 20 kilometers where applicable, since the only mobile team in Hosingo is overstretched. b) There is a major GAP of MALARIA treatment drugs as malaria remains endemic in the area. c) There is strong need of integrating nutrition Interventions in all facilities. IOM/SFH Supported health facilities/teams remained the only source of health services in most areas. 5

Number reached d) Continuous provision of program supplies without interruption or breakage is inevitable for delivery of

Consultations and Managements for MAY and JUNE 2017 4000 3000 2000 1000 0 <5 Boys <5 Girls >5 Male >Female Series1 1330 3241

29.1% of the <5 consultations were boys while the girls make up to 70.9% of the total < 5 consultations and managements.

6 Number reached d) Continuous provision of program supplies without interruption or breakage is inevitable for delivery of quality service in all centers. Consultations and Managements for MAY and JUNE <5 Boys <5 Girls >5 Male >Female Series The graph above shows the total consultations and treatments done during the period of May and June by all the teams. 29.1% of the <5 consultations were boys while the girls make up to 70.9% of the total < 5 consultations and managements. The same major disparity exist among the >5 male and female cases where 39.7% of the consultations were male and female account for 60.3% of the total >5 consultations. Figure 2: ANC and EPI remain core PHC services in all the facilities. 6

7 2. BACKGROUND INFORMATION While Somalia continues to be on a positive political trajectory after decades of political turmoil, acute humanitarian needs persist and basic social indicators remain among the lowest in the world. The country has some of the worst health and Nutrition indicators in the world and didn t achieve any health related MDG before. In the absence of a structured government health system and facilities in Somalia, IOM more than ever before, is a key provider of humanitarian services. As health and nutrition situations deteriorate and the effect of drought bite ½ of the Somalia populations, there has been robust need to scale up humanitarian programs in south central Somalia. The IOM supported PHC Programme has been able to continue in partnership with SFH in Hosingo, Dobley and neighboring villages along the Kenya- Somalia border. Access to good quality health care is still extremely limited, in particular in rural areas. It remains fragmented, unregulated and mostly in the hand of private actors with a significant proportion of traditional healers. Where a clinic exists, the referral of cases in need of hospitalization is often not possible as peripheral often lack essential equipment/materials and have staff with only very basic training. Insecurity and population displacements prevented vaccination of over half-million young children. Linked to this immunization deficit and the poor access to sanitation and water, the control of common communicable diseases is difficult, especially Acute Respiratory tract Infections and acute watery diarrhea. Displaced children and pregnant woman are and will remain the most affected population in terms of poor health and nutrition status in the immediate future. Lack of water supply has resulted in increasing hygiene and sanitation related problems, including rising number of reported cases of Acute Watery Diarrhea (AWD)/ cholera. With an increasing number of individuals at risk of food insecurity, the previously estimated 5 million people in need of humanitarian assistance has gone up to 6.2 million. Between February and June 2017, the number of IDPs increased from 1.1 million to 3 million individuals. Furthermore, the Health and Water, Sanitation and Hygiene (WASH) Cluster estimated that about 3.3 million people will be in need of improved access to WASH services and emergency healthcare due to the worsening drought situation in Somalia (OCHA Operational Plan for Pre-Famine Scale Up). 7

8 Migrants and Mobile Populations (MMPs) and their affected communities are the most vulnerable populations in Somalia. It is on this background that SFH in partnership with IOM established 3 Mobile clinics in April this year in an attempt to provide emergency primary health care services to drought and AWD affected populations in Afmadow district and part of Badhadhe district. 3. GENERAL OBJECTIVE The principle objective of the project was: To provide emergency primary health care services to the drought affected populations in Afmadow districts SPECIFIC OBJECTIVE Provide curative (including treatment of AWD/Cholera) and préventives Heath services to 28,800 beneficiaries (10,080 girls, 8,640 boys, 5,760 women, 4,320 men) for IDPs and drought affected populations. Vaccinate 1000 children under the age of 5 and 500 women of child bearing age from vaccine preventable diseases Strengthen the referral system to Dobley and other hospitals for patients in need of secondary healthcare services including malnourished children and mothers to Targeted Supplementary Feeding Programme (TSFP)/stabilization center (SC), ensuring equal access of services for women, men, girls and boys. Conduct awareness raising activities to raise awareness of common communicable diseases among IDPs, drought affected and host communities in a culturally acceptable manner with a particular focus on AWD/Cholera, childhood illnesses, maternal Heath, malaria and malnutrition related morbidités 4. PROGRESS MADE TOWARDS REALIZING OUTCOMES* AND OUTPUTS by END of JUNE 2017 A) GENERAL ACHÈVEMENTS Activity Planned Timeline Achievement 1.1 Project launch 15 th April The project was launched successfully in both Hosingo 8

9 and stakeholders briefing 1.2 Mobile Vehicle Hire 1.3 Staff recruitment and engagement 1.4 Establishment of mobile teams and operationalizat ion of services 1.5 Orientation training for the teams 1.6 Drugs requisition and supply 1.7. Data collection and Activity Reporting 2017 and Dhobley with no challenge. Stakeholders including the local administration, local health committees, partner LNGOs were briefed on the project implementation including identification of mobile sites. 15 th April th April th April th April th April 2017 As scheduled 3 vehicles were hired by the organization for the mobile teams. The vehicles with capacity to accommodate both team and drugs were identified for effective service delivery The activity was successfully achieved and recruitment of qualified personnel done in accordance with the SFH HR policy. The process that was transparent and done in consultation with local authority and key stakeholders. The team prioritized qualified medical workers from the locality who have understanding of the area and will help in follow up of cases. The recruitment ensured gender balance is given a priority. 3 Auxiliary nurses, 3 community health workers,3 vaccinators, 3 Qualified Nurses, 3 Midwives, 3 drug dispensers,1 health manager and health supervisor were successfully engaged for the mobile teams 3 mobile teams were established 2 in Dhobley and one in Hosingo and equipped with chairs, stationaries and reporting tools to ensure services is not delayed An orientation training was held for the teams by IOM field teams and SFH on project overview, quality service provision, community participation to enhance ownership, record keeping and reporting for data management Arrangements for drug requisition, supply and storage was done from IOM stores in Dhobley. SFH provided space for bi-weekly drug storage for the mobile teams with adequate security. Activity reporting to the cluster, IOM was clarified. Data is submitted to the cluster and IOM data management team on every Monday for weekly reports and well on monthly basis for HMIS data using the appropriate 9

10 standard tools. B) EXPECTED OUTPUT Activity # Activity Planned Achieved % Achieved 1. Proved curative (including 28,800 15, % treatment of AWD/Cholera) and preventive Health services to 28,800 beneficiaries (10,080 girls, 8,640 boys, 5,760 women, 4,320 men) for IDPs and drought affected populations. 2. Vaccinate 1000 children under the age of 5 and 500 women of child % bearing age from vaccine preventable diseases 3. Strengthen the referral system to Dhobley and other hospitals for patients in need of secondary Continuous referral throughout 29 cases Ongoing healthcare services including the project malnourished children and where mothers to Targeted applicable. Supplementary Feeding Programme (TSFP)/stabilization center (SC), ensuring equal access of services for women, men, girls and boys. 4. Conduct awareness raising activities to raise awareness of common communicable diseases among IDPs, drought affected and host communities in a culturally acceptable manner with a particular focus on AWD/Cholera, childhood illnesses, maternal Heath, malaria and malnutrition related morbidities. Daily sessions to be conducted at each center Persons reached directly through promotion sessions. Ongoing daily. C) GENDER INDICATOR ACHIEVEMENTS SO FAR Gender Target Achieved % Achievement Boys % 10

% Achieved Girls 10,080 3241 32.2% Men 5760 4494 78.02% Women 4320 6470 149.7% An immense boy child under achievement is noted in the 1 st 2 month of the project implementation period.

However, the patriarchal nature of the Somali community put the boy child a heavy burden of doing outside house activities and taking it to a health facility might not possible and this can be

11 % Achieved Girls 10, % Men % Women % An immense boy child under achievement is noted in the 1 st 2 month of the project implementation period. There is no clear reason attributed to low boys turn-out in the Health facilities. However, the patriarchal nature of the Somali community put the boy child a heavy burden of doing outside house activities and taking it to a health facility might not possible and this can be barrier to access. Gender Marker Achievements % % % % 80.00% 60.00% 40.00% 20.00% 0.00% % 78.02% 32.20% 15.30% Boys Girls Men Women GENDER The graph above shows the graphic presentation of specific gender achievements. Besides, the graph shows 149.7% was achieved for women with least boys reached at 15.3% as tabulated above. D) OTHER DELIVERABLES ACHIEVED 11

Figure 3: HHN sessions conducted by Hosingo team #

12 Figure 3: HHN sessions conducted by Hosingo team # Deliverable Achieved 1. HHN Promotion sessions ANC PNC WCBA persons were directly reached with Health, Hygiene and Nutrition (HHN) sessions. This number is expected to replicate the sessions to the entire communities. Besides, 423, 173 and 1302 ANC, PNC and WCBA visits were consulted and managed. Figure 4: SFH Vaccinator administering different vaccines at Hosingo health facility. 12

29 referrals were made during the period of which 27 were successfully treated and discharged and 2 died while on treatments.

13 5) REFERRALS Significant numbers of referrals were made during the period. Dhobley was the main destination for all health referrals including but not limited to:- the severely malnourished cases, complicated births and major surgeries. 29 referrals were made during the period of which 27 were successfully treated and discharged and 2 died while on treatments. The pictures below describe successful referral procedures from Hosingo health facility. 6) CHALLENGES Overwhelming population in need of treatments is the biggest challenge that straining the few staffs for mobile teams. Severely malnourished cases with Edema (+++) are identified in the centers on daily basis and nothing much can be done since the program is not integrated with Nutrition Intervention in the Area. However, referrals are done where applicable and sent to Dhobley health facilities Shortage of drugs as in the case of Malaria treatment drugs was a major issue and need to be addressed urgently. Lack of basic health services in most permanent settlements in Badhade district remain a major challenge 13

14 Teenage pregnancies as a result of early marriages are some of the major causes of obstetric complications in the communities especially at the rural areas Lack of safe and clean water supply for the communities along Kenya- Somalia border villages and Hosingo thus recurrent outbreak of water borne diseases like acute watery diarrhea and cholera 5. RECOMMENDATIONS All possible efforts should be made to continue providing the vital services in all the accessible health facilities in Badhadhe with the inclusion of more community outreach component (Mobile) to the accessible rural villages within a radius of 20 kilometers where applicable, since the only mobile team in Hosingo is overstretched. There Is a major GAP of MALARIA treatments drugs as malaria remain endemic in the area. There is strong need of integrating nutrition Interventions in all facilities. IOM/SFH Supported Heath facilities/centres remained the only source of health services in most of these areas. Continuos provision of program supplies without interruption or breakage is inevitable for delivery quality service in all centers. Provision of basic nutrition services in Badhade district starting with Hosingo MCH Long- term clean and safe water supply in the rural villages along Kenya- Somalia border and Badhade district Need for community trainings on proper use of few available latrines Regular staff trainings on Primary health services to improve on their capacity to provide quality services Thanks 14

Somalia Is any part of this project cash based intervention (including vouchers)? Conditionality:

Somalia Is any part of this project cash based intervention (including vouchers)? Conditionality: Somalia 2018 Appealing Agency Project Title Project Code Sector/Cluster Refugee project Objectives HEALTH POVERTY ACTION (HPA) Emergency Nutrition Interventions for IDPs in Somaliland 2018 (NutriSom) SOM-18/N/121295